维生素D不足与卒中的荟萃分析

目的探讨维生素D不足是否为卒中危险因素。方法英文以PubMed、Cochrane Library、EMBASE作为检索数据库,以25-hydroxy vitamin D(25[OH]D)、vitamin D与stroke为主题词进行检索;中文以中国学术期刊网全文数据库(China National Knowledge Infrastructure,CNKI)、万方科技期刊全文数据库(Wanfang Data)、重庆维普中文科技期刊全文数据库(VIP)作为检索数据库,以维生素D、卒中、脑梗死、脑血栓形成为关键词进行检索,时间截止到2013年1月。用stata12.0软件进行Meta分析计算合并HR值(95%CI)。结果共纳入12篇文献,总样本量为28824。荟萃分析结果显示25(OH)D不足者与充足者相比的HR值(95%CI)是1.53(95%CI,1.43-1.64),差异有统计学意义(P0.05)。结论维生素D不足可能是卒中的一个潜在危险因素,对人群进行维生素D干预尚需进一步研究。     

术前激素治疗在局限性前列腺癌治疗中的地位：一项基于6个随机对照试验的荟萃分析

背景：研究已证实术前激素治疗减低了前列腺癌患者的临床分期和病理分期,减少了切缘阳性率,但是并没有提高患者的无病生存率。目前术前激素治疗前列腺癌的价值尚无定论。 目的：评价术前激素治疗在治疗局限性前列腺癌中的作用。 方法：计算机检索PubMed、EMBASE、Cochrane Library(2009年第4期)、中国生物医学文献数据库、中国期刊全文数据库、维普中文科技期刊数据库中2009年10月前发表的文章,手工检索相关领域的杂志。纳入随机对照试验,经病理学及细胞学检查确诊为局限性前列腺癌的患者,性别和民族不限,没有严重的心肺疾病;排除晚期或是复发的前列腺癌患者。同时从纳入文献的参考文献中查找符合要求的随机对照试验。采用国际Cochrane协作组提供的Revman 5.0软件进行统计分析。主要评价无病生存率、切缘阳性率、淋巴结阳性率、精囊浸润率4个结局指标。 结果与结论：共纳入6篇随机对照试验合计1 027人,meta分析结果显示：与单纯的前列腺癌手术相比,术前激素治疗联合前列腺癌手术在无病生存率[RR=1.02,95%CI (0.89,1.17)],淋巴结阳性率[RR=0.86,95%CI (0.47,1.57)]、精囊浸润率[RR=1.09, 95%CI (0.74,1.59)]方面差异无显著性意义,而在手术切缘阳性率[RR=0.46,95%CI (0.32,0.66)]方面差异有显著性意义。提示术前激素治疗联合前列腺癌根治术能减低局限性前列腺癌患者的手术切缘阳性率,但是并不能提高患者的无病生存率、淋巴结阳性率、精囊浸润率。     

维生素E治疗TD的研究现状

长期使用神经阻滞剂的病人容易产生迟发性运动障碍(以下简称 TD),其发生率大概为20%,年龄大的病人,TD 发生率较高。TD 的治疗比较困难,已被试用过的药物有:多巴胺拮抗剂、拟胆碱药(如毒扁豆碱)、GABA 能药物(如苯二氮类药和丙戊酸钠)以及去甲肾上腺素能抑制剂(如可乐宁)等,但总的来说,疗效都不很满意,迄今仍未找到治疗 TD 的好方法。近5年来,国外有人报道维生素 E 治疗 TD 可收到一定疗效,本文就这一方面的研究现状及可能的作用机制作一介绍,希望能发现一种治疗的新方法。     

缺血性脑血管病患者血清内源性抗氧化剂维生素C、维生素E的测定及临床意义

目的探讨维生素Ｃ（ＶｉｔＣ）、维生素Ｅ（ＶｉｔＥ）的抗氧化作用。方法应用紫外分光光度法测定了５８例缺血性脑血管病患者和２３例正常对照组血清ＶｉｔＣ、ＶｉｔＥ、超氧化物歧化酶（ＳＯＤ）和丙二醛（ＭＤＡ）的含量。结果在脑供血不足组，ＶｉｔＣ、ＶｉｔＥ、ＳＯＤ含量略降低，ＭＤＡ含量略升高；而在脑梗塞急性期，ＶｉｔＣ、ＶｉｔＥ、ＳＯＤ含量明显降低，ＭＤＡ明显升高；恢复期均恢复正常。结论以ＭＤＡ为代表的自由基代谢产物参与了脑缺血性细胞损伤的病理生理过程；而内源性抗氧化剂ＶｉｔＣ、ＶｉｔＥ、ＳＯＤ可作为一个敏感指标，早期证实脑缺血的发生，推测缺血的严重程度。     

维生素E缺乏的神经—肌肉综合征

近年来证实,维生素E(Tocophenol α—生育酚)缺乏是引起某些神经—肌肉损害的原因之一。1931年Pappenheimer等证实维生素E缺乏的鸡可表现为小脑性共济失调。以后,在鼠、兔、猴等许多动物实验中也都证明维生素E缺乏可引起肌肉、周围神经、脊髓和/或小脑的严重损害。人类维生素E缺乏所致神经—肌肉损害,可追溯至1907年Bramwell所发现1例脂肪痢患者,因维生素E缺乏合并肌病。以后,Clayton(1965年)报道4家系7例家族性特发性肝内胆汁郁滞症继发维生素E缺乏性共济失调(Byler病)。近年来     

维生素E治疗迟发性运动障碍的初步观察

近年来国外有人报道,应用大剂量维生素E(VE)治疗迟发性运动障碍有效。为此,我们于1993年2月—1993年4月,选择临床明确诊断的TD患者,应用大剂量VE治疗,并采用异常不自主运动评定量表(AIMS)进行治疗前后的评分对照观察。现将我们的结果报告如下。     

癫痫患儿血清丙二醛及维生素E水平测定

以本文测定４５例癫痫患儿（其中发作期患儿２０例，控制期患儿２５例）血清丙二醛及维生素Ｅ，并与４０例正常小儿进行对照。结果显示癫痫控制期患儿与对照组间丙二醛及维生素Ｅ值接近；癫痫发作期患儿与对照组比较，维生素Ｅ值明显下降（Ｐ＜０．０５），丙二醛呈上升趋势。此结果提示脂质过氧化可能参与了癫痫的病理过程。     

高血压患者血中SODLPO与维生素E的关系初探

探讨高血压患者血中SOD、LPO及维生素E之间的相互关系。检测46例高血压及50例正常对照组血中SOD、LPO及维生素E含量并做相关分析。结果显示观察组中SOD均值较对照组明显降低（P＜0．01）,LPO均值较对照组显著升高（P＜0．05）二者呈负相关系。观察组中取维生素E者血中维生素E水平可以提高（P＜0．05）。提示SOD、LPO及维生素E在高血压的发展中有一定的协同作用,氧自由基（OFR）能促进动脉粥样硬化的发展,维生素E具有抗氧化作用。     

维生素E对脑梗死患者低密度脂蛋白氧化延迟时间的影响

目的 探讨维生素E治疗对脑梗死患者血液中低密度脂蛋白体外氧化延迟时间的影响.方法 选取22例脑梗死患者作为治疗组.给予维生素E(300mg/d)治疗;选取22例年龄、性别、血压、病灶部位及程度与治疗组相当的腩梗死患者作为对照组,小给予维生素E治疗.收集患者发病24 h以内和发病2周时血清,测定血样中低密度脂蛋白体外氧化延迟时间,同时测定血清中维牛素E浓度,低密度脂蛋白中的总胆固醇、三酰甘油、游离胆固醇.结果 治疗组患者2周时血样中低密度脂蛋白体外氧化延迟时间明显长于对照组[(71.84±9.75)min vs(60.95±9.33)min],差异有统计学意义(P<0.05).血清中维牛素E的浓度明显高于对照组[(17.41±5.24)ìmol/L vs(12.90±6.27)ìmol/L],差异有统计学意义(P<0.05),且与卒中症候呈现负相关趋势.治疗组与对照组静脉血中低密度脂蛋白中的总胆固醇、三酰甘油、游离胆固醇差异无统计学意义[分别为(5.08±0.61)vs(4.72±0.61)mmol/L;(0.88±0.06)mmol/Lvs (0.84±0.03)mmol/L;(1.62±0.41)vs(1.65±0.92)mmol/L].结论给予维生素E治疗可以增加急性期脑梗死患者血液中低密度脂蛋白体外氧化延迟时间,增强患者体内的抗氧化能力.     

共济失调伴选择性维生素E缺乏症的研究进展

共济失调伴选择性维生素Ｅ(ＶｉｔＥ)缺乏症(ＡＶＥＤ)为一种常染色体隐性遗传病,又称家族性单纯ＶｉｔＥ缺乏症(ＦＩＶＥ),其临床特征为共济失调,腱反射减弱或消失,深感觉障碍,构音障碍及ＶｉｔＥ缺乏。因其临床表现与Ｆｒｉｅｄｒｅｉｃｈ共济失调(ＦＲＤＡ)很相似,曾被误认为ＦＲＤＡ的临床变异型,在诊断时易被混淆。目前已知本病为α生育酚(ＶｉｔＥ的主要形式)转运蛋白(αＴＴＰ)的基因一系列突变导致αＴＴＰ的转运功能障碍,引起ＶｉｔＥ在血及组织中浓度下降,从而引发一系列神经系统及其他组织的损伤。该基因已定位于8ｑ13.1～13.3,…     

Effect of vitamin E supplementation in patients with ataxia with vitamin E deficiency

Ataxia with vitamin E (Vit E) defciency (AVED) is an autosomal recessive disorder caused by mutations of the alpha tocopherol transfer protein gene. The Friedreich ataxia phenotype is the most frequent clinical presentation. In AVED patients, serum Vit E levels are very low in the absence of intestinal malabsorption. As Vit E is a major antioxidant agent, Vit E deficiency is supposed to be responsible for the pathological process. Twenty-four AVED patients were fully investigated (electromyography, nerve conduction velocity (NVC) studies, somatosensory evoked potentials, cerebral computed tomography scan, sural nerve biopsy, genetic studies) and supplemented with Vit E (800 mg daily) during a 1-year period. Clinical evaluation was mainly based on the Ataxia Rating Scale (ARS) for cerebellar ataxia assessment and serum Vit E levels were monitored. Serum Vit E levels normalized and ARS scores decreased moderately but significantly suggesting clinical improvement. Better results were noted with mean disease duration < or = 15 years. Reflexes remained abolished and posterior column disturbances unchanged. Vitamin E supplementation in AVED patients stabilizes the neurological signs and can lead to mild improvement of cerebellar ataxia, especially in early stages of the disease.     

Oxidation of vitamin E and vitamin C and inhibition of brain mitochondrial oxidative phosphorylation by peroxynitrite

The effects of peroxynitrite (PN; product of the reaction between nitric oxide and superoxide) on mitochondrial respiration as well as oxidation of alpha-tocopherol and ascorbic acid were studied. Mitochondria were isolated from brain hemispheres of 4-month-old male Fisher rats by standard centrifugation procedures utilizing Ficoll gradients. Treatment of brain mitochondria with PN caused a concentration-dependent impairment of oxidative phosphorylation and depletion of the endogenous antioxidants alpha-tocopherol and ascorbic acid. PN-induced mitochondrial dysfunction was characterized by 1) decreases in state 3 respiration and oxidative phosphorylation, 2) loss of respiratory control [ratio of ADP-stimulated (state 3) to basal (state 4) respiration], and 3) uncoupling of oxidative phosphorylation. PN did not function as a pure uncoupler, insofar as the increase in state 4 respiration was accompanied by a larger decrease in state 3 respiration. This contrasts with the uncoupling action of the protonophore carbonyl cyanide m-chlorophenylhydrozone, which increases both state 3 and state 4 respiration. PN-induced reduction in respiratory control and oxidative phosphorylation closely paralleled the oxidation of membrane tocopherol and were preceded by loss of ascorbate. alpha-Tocopherol (the most potent biological lipid antioxidant) may have a unique role in protecting mitochondrial membranes from oxidative stress. The two antioxidant nutrients alpha-tocopherol and ascorbate (which interact with each other and glutathione) may be intimately involved in protecting mitochondria in situations in which excessive release of superoxide and nitric oxide occurs under normal and/or pathological conditions.     

齐拉西酮治疗精神分裂症临床观察：齐拉西酮治疗精神分裂症对照研究的Meta分析

目的：探讨齐拉西酮治疗精神分裂症的疗效和不良反应。方法：应用Meta分析对12项研究齐拉西酮与其他抗精神病药治疗精神分裂症对照研究的文献进行再分析。结果：齐拉西酮治疗精神分裂症前后症状学变化差异有非常显著性（P〈0．01），效应极强。与对照组比较疗效差异无显著性（P〉0．05）。齐拉西酮组的失眠不良反应较其他抗精神病药组多（P〈0．01），月经紊乱、锥体外系反应、体质量增加等均较对照组少（P〈0．05或P〈0．01）。结论：齐拉西酮与对照组的疗效相仿，起效快，不良反应较少。     

The effect of intravenous vitamin E and menadiol sodium diphosphate on vitamin K dependent clotting factors

During a Phase I study of intravenous vitamin E-free alcohol (all-rac-a-tocopherol or Ephynal®) in patients with neuroblastoma, we noticed a bleeding diathesis in two patients receiving 2300 mg/m² daily for four or more days in succession. Both blood prothrombin time and acclerated partial thromboplastin times were prolonged. These spontaneously returned to normal levels three days after interrupting vitamin E infusions. It was also noted that factors VII, IX and X were decreased, which corresponded with the prolonged PT and APTT. It was found that by infusing menadiol sodium diphosphate just prior to the vitamin E, these inhibiting effects on procoagulant factors could be abrogated and high dosages of vitamin E-free alcohol safely given.     

Harmony seeking and the risk of prostate cancer: a prebioptic study

OBJECTIVE: This semiprospective case-control study was performed to investigate the relationship between harmony-seeking personality and the occurrence of prostate cancer. METHODS: Out of 217 consecutive participants admitted to hospital for biopsy, 86 and 81 were classified into the case and control groups, respectively, based on their initial diagnosis and eligibility criteria. The participants answered several questionnaires after admission. The logistic regression model was used for multivariate analyses to assess the association. RESULTS: "Harmony-seeking personality" was selected as the only psychological variable significantly contributing to the model, while "family history of prostate cancer" as the only somatic variable. "Harmony-seeking" maintained a significant contribution to the model, also including "family history" and even to the model adjusted by "patient prediction of cancer diagnosis" and "prostate-specific antigen" (PSA), probably related to the consequences of the disease. CONCLUSION: The harmony-seeking personality could differentiate between groups of men with and without prostate cancer.     

Apolipoprotein E exerts selective and differential control over vitamin E concentrations in different areas of mammalian brain

Apolipoprotein E (apoE) is known to be a risk factor for the incidence of Alzheimer's disease (AD). In addition, vitamin E has been reported to have a role in the treatment of AD. We examined the potential interrelationship between vitamin E and apoE in brain. As the first step, we determined the concentrations of alpha-tocopherol in selected brain regions of apoE-deficient mice at different ages. The mice were fed normal rodent chow. All regions of the brain in apoE-deficient mice contained less alpha-tocopherol than control samples at 2.5 months of age, the initial time of study. This trend continued for 9.5 months for most regions except the spinal cord and cerebellum. Tocopherol levels in these latter regions of apoE-deficient animals increased to control levels during the study. Serum alpha-tocopherol and cholesterol levels were high in the apoE-deficient animals; however, the CNS cholesterol levels were the same in apoE-deficient and control mice. This suggests that 1) the decline in brain alpha-tocopherol in apoE deficiency is not due to overall alterations in lipid metabolism; and 2) the processing of alpha-tocopherol in brain follows a separate pathway than that of cholesterol. Subcellular concentrations of alpha-tocopherol were unaltered by apoE deficiency indicating that intracellular handling of tocopherol is not affected by apoE. ApoE may be an important protein controlling vitamin E levels in specific brain regions. Further understanding of the interactions between apoE and vitamin E could be important in the appropriate use of vitamin E in AD.     

全髋关节置换术后应用非甾体类抗炎药有效性和安全性的荟萃分析

[摘要] 目的 用荟萃分析的方法定量评价全髋关节置换术后（THA）应用非甾体类抗炎药（NSAIDs）的有效性和安全性。方法 计算机检索PubMed、EMBASE、Cochrane Library、CBM、CNKI、VIP数据库,追查纳入文献的参考文献,全面搜集有关THA 后应用NSAIDs的随机对照试验（RCT）,用RevMan5.0软件进行统计分析。结果 共纳入13篇RCT( 4706例患者),meta分析结果显示：与安慰剂组相比,低剂量的阿司匹林组与在预防异位骨形成（HBF）方面差异无统计学意义[RR=0.99, 95%CI (0.87, 1.14),而中到高剂量的NSAIDs组在预防HBF方面差异有统计学意义[RR=0.44, 95%CI (0.30, 0.64);在轻度的胃肠道不良反应方面差异两组差异有统计学意义[RR=2.15, 95%CI (1.28 3.61)],在改善髋关节疼痛方面和躯体功能方面差异无统计学意义[MD=-0.1, 95CI%(-0.1, 0.4)];7 Gy放疗组和NSAIDs相比HBF发生率分别是11.1%和16%。结论 除低剂量的阿司匹林外,全髋关节置换术后应用中到高剂量NSAIDs可显著减低患者异位骨的形成,但NSAIDs组轻度的胃肠道反应较高,有限的证据表明NSAIDs和安慰剂组在髋关节疼痛的缓解和躯体功能的改善方面无差异,7 Gy放疗组在减低异位骨形成发生率方面优于NSAIDs组。     

High dose vitamin E therapy in amyotrophic lateral sclerosis as add-on therapy to riluzole: results of a placebo-controlled double-blind study

Summary. Increasing evidence has suggested that oxidative stress may be involved in the pathogenesis of amyotrophic lateral sclerosis (ALS). The antioxidant vitamin E (alpha-tocopherol) has been shown to slow down the onset and progression of the paralysis in transgenic mice expressing a mutation in the superoxide dismutase gene found in certain forms of familial ALS. The current study, a double blind, placebo-controlled, randomised, stratified, parallel-group clinical trial, was designed to determine whether vitamin E (5000mg per day) may be efficacious in slowing down disease progression when added to riluzole. Methods. 160 patients in 6 German centres with either probable or definite ALS (according to the El Escorial Criteria) and a disease duration of less than 5 years, treated with riluzole, were included in this study and were randomly assigned to receive either alpha-tocopherol (5000mg per day) or placebo for 18 months. The Primary outcome measure was survival, calculating time to death, tracheostomy or permanent assisted ventilation, according to the WFN-Criteria of clinical trials. Secondary outcome measures were the rate of deterioration of function assessed by the modified Norris limb and bulbar scales, manual muscle testing (BMRC), spasticity scale, ventilatory function and the Sickness Impact Profile (SIP ALS/19). Patients were assessed at entry and every 4 months thereafter during the study period until month 16 and at a final visit at month 18. Vitamin E samples were taken for compliance check and Quality Control of the trial. For Safety, a physical examination was performed at baseline and then every visit until the treatment discontinuation at month 18. Height and weight were recorded at baseline and weight alone at the follow-up visits. A neurological examination as well as vital signs (heart rate and blood pressure), an ECG and VEPs were recorded at each visit. Furthermore, spontaneously reported adverse experiences and serious adverse events were documented and standard laboratory tests including liver function tests performed. For Statistical Analysis, the population to be considered for the primary outcome measure was an intent-to-treat (ITT) population which included all randomised patients who had received at least one treatment dose (n=160 patients). For the secondary outcome measures, a two way analysis of variance was performed on a patient population that included all randomised patients who had at least one assessment after inclusion. Results. Concerning the primary endpoint, no significant difference between placebo and treatment group could be detected either with the stratified Logrank or the Wilcoxon test. The functional assessments showed a marginal trend in favour of vitamin E, without reaching significance. Conclusion. Neither the primary nor the secondary outcome measures could determine whether a megadose of vitamin E is efficacious in slowing disease progression in ALS as an add-on therapy to riluzol. Larger or longer studies might be needed. However, administration of this megadose does not seem to have any significant side effects in this patient population.     

Cerebrospinal fluid levels of alpha-tocopherol (vitamin E) in Alzheimer's disease

Summary We compared CSF and serum levels, and the CSF/serum ratio of alpha-tocopherol (vitamin E), measured by HPLC, in 44 apparently well-nourished patients with Alzheimer's disease (AD) and 37 matched controls. CSF and serum vitamin E levels were correlated, both in AD patients and in controls. The mean CSF and serum vitamin E levels were significantly lower in AD patients, and the CSF/serum ratio of AD patients did not differ significantly between the 2 study groups. CSF vitamin E levels did not correlate with age, age at onset, duration of the disease and score of the Minimental State Examination in the AD group. Weight and body mass index were significantly lower in AD patients than in controls. These results suggest that low CSF and serum vitamin E concentrations in AD patients could be related with a deficiency of dietary intake of vitamin E.